Persistent hyperbilirubinemia in a B Cell Non-Hodgkin’s lymphoma: a case of suspected paraneoplastic cholestasis

Lordan Carreon. MD

Introduction: Lymphoma can sometimes infiltrate the liver and cause persistent bilirubinemia. A liver biopsy may be warranted to exclude the diagnosis.

Presentation of Case: A 73-year old female presented with subacute onset of jaundice. Full review of the patient's data and medications failed to reveal any possible causes. Comprehensive testing including PET CT and MRCP failed to reveal any signs of obstruction. A biopsy was done on an incidental finding of renal mass which showed B cell non-Hodgkin lymphoma. The patient’s status eventually deteriorated and liver biopsy was not done.

Discussion: Lymphoma may cause jaundice by both infiltration within the liver or by obstruction at the porta hepatis. Liver biopsy may help provide the diagnosis. However, a cholestatic form of jaundice has been described in association with lymphoma as an extrahepatic manifestation, presumably related to the release of a cholestatic factor which is still not yet identified.

Conclusion: Lymphoma can cause jaundice by infiltration of the liver, biliary obstruction or through cholestasis. Paraneoplastic cholestasis is an  extrahepatic manifestation of non-Hodgkin's lymphoma which has not yet been fully described.